Information Regarding Transexualism

Dr Russell W. Reid

M.B.,Ch.B.,M.R.C,Psych Consultant Psychiatrist, St. Bernards Hospital, Middlesex and the London Institute, 10 Warwick Road
Gendys Conference, 1990

 
Transexualism is a frustrating condition for anyone to have to live with. The transexual person is not at peace with himself or herself and is likely to be misunderstood by others. The cause of the condition is unknown and there is no known cure for it. It is not a mental illness, it is not a sexual perversion or a wilfully adopted mode of behaviour. Nor is it a form of homosexuality although it is possible to be both homosexual and transexual. It differs from transvestism where the person enjoys and feels comfortable, and may be sexually aroused, by clothes of the opposite sex. However, transvestites generally don't want to physically change sex.

Everyone nowadays has heard about "Sex Change" and with the advent of synthetic sex hormones in the early fifties it became possible to help transexuals adjust into the gender role which they believed to be appropriate for themselves. Assessment and monitoring of this process is usually carried out at a Gender Identity Clinic (GIC). The GIC staff provide regular counselling and liaise with GPs in prescribing hormones. Some GICs have grooming classes where deportment, speech therapy, clothes sense, make-up and hairstyling are all discussed and practised.

Although there are many transexual people for whom all this risk and effort is worthwhile in terms of their being able to have a better quality of life afterwards, this is not always the case. The person's fantasy that he/she could live in the opposite gender role, appear physically to be a member of that gender and to be accepted by family, friends and employers in that gender often remains unfulfilled despite all the effort. Moreover a biological male can never have a uterus nor can a biological female ever have a functioning penis. A male with a deep voice, heavy growth of facial hair, prominent Adam's apple, receding hair line and other characteristically masculine features can seldom if ever pass in public as a female despite the best will in the world. Many transexuals have such a strong urge to be a member of the opposite sex that they have great difficulty in accepting these undeniable facts. Some will put a lot of pressure on GIC staff to help them "change sex" but more often than not the responsible work of the GIC staff is to protect the person from setting out on a disastrous course.

Many "gender dysphoric" persons who by definition are dissatisfied with their gender, i.e. their sense of masculinity or femininity, request opposite sex hormones. In the case of gender dysphoric men, the prescribing of female hormones sometimes does provide some subjective sense of satisfaction and relief. Female hormones, being sexual tranquillisers, often seem to take the edge off compulsive and preoccupying transvestite urges. They do this through their antilibidinal effect.

The person must be able to appear and be accepted by others in the aspired gender. It is no good merely hoping that surgical intervention will "do the trick" and change the attitude of others.

Physical and psychological health must be of a degree to ensure that the person can withstand the effects and dangers of the reversal procedures. There are for instance some physical conditions in which it would be very dangerous to prescribe certain hormones.

Although most documents can be changed into the name of the opposite sex once the person has changed name by Deed Poll or Statutory Declaration the name on the Birth Certificate cannot, under existing law, be changed, and in England at present legal marriage cannot take place.

Before gender reversal can even be contemplated by GIC staff all these aspects must be fully considered and frankly faced. When all is said and done, doctors and psychologists work in GIC's because they clearly recognise the difficulties and predicaments of transexual people. Whether "change" is possible or not the role of the staff is to understand and support the person and, if considered helpful, to explain matters and counsel not only the individual but also family and friends and anyone else who might be able to help if they had a better understanding of the problem.